Bill Gatton College of Pharmacy, East Tennessee State University, Johnson City, TN, USA.
Ann Pharmacother. 2013 Jan;47(1):63-74. doi: 10.1345/aph.1R331. Epub 2013 Jan 16.
The American Academy of Orthopaedic Surgeons (AAOS) and the American College of Chest Physicians (ACCP) have both developed evidence-based guidelines to prevent venous thromboembolism (VTE) in high-risk orthopedic surgery patients. Recent changes to these documents have brought them into agreement as to the inclusion of aspirin as an appropriate option for VTE prophylaxis in this patient population.
To evaluate the appropriateness of aspirin to prevent VTE in high-risk orthopedic surgery patients.
Guidelines published by the AAOS in 2011 and the ACCP in 2012 were compared regarding their recommendations on the use of aspirin for the prevention of VTE. A literature search was also conducted to identify clinical trials that evaluated the use of aspirin for the prevention of VTE in this patient population. Search terms included the MeSH terms venous thromboembolism; venous thrombosis; pulmonary embolism; aspirin; arthroplasty, replacement, knee; arthroplasty, replacement, hip; and hip fractures/surgery.
Any study that evaluated aspirin, even in combination with another method of prophylaxis (such as pneumatic compression devices), and had been published during or after 1985 was included.
Randomized controlled trials, meta-analyses, and other large pooled and retrospective reviews have failed to consistently arrive at similar conclusions regarding the efficacy and safety of aspirin as an option for VTE prophylaxis in patients undergoing total knee arthroplasty (TKA), total hip arthroplasty (THA), or hip fracture surgery (HFS). Disagreements in the appropriateness of surrogate markers for safety and efficacy have resulted in differing recommendations from the ACCP and AAOS. The primary argument lies in the appropriateness of deep vein thrombosis as a surrogate marker for more serious outcomes such as pulmonary emboli.
Recent changes to both the ACCP and AAOS guidelines are in agreement for those who choose to use aspirin for chemoprophylaxis of VTE. Current surgical care improvement project measures do not include aspirin as an appropriate sole option for the prevention of VTE, but in patients undergoing elective TKA or who have a contraindication to pharmacologic prophylaxis and undergo a THA or HFS, aspirin in conjunction with compression devices as part of a multimodal approach would meet these measures. Data do not support the hypothesis that aspirin is less likely to cause adverse bleeding events than more potent anticoagulants.
美国骨科医师学会（AAOS）和美国胸科医师学会（ACCP）都制定了预防高危骨科手术患者静脉血栓栓塞症（VTE）的循证指南。这两份文件最近的更新使其在将阿司匹林纳入高危骨科手术患者 VTE 预防的合适选择方面达成一致。
评估阿司匹林预防高危骨科手术患者 VTE 的适宜性。
比较了 AAOS 2011 年和 ACCP 2012 年发布的指南，以了解其关于阿司匹林预防 VTE 的使用建议。还进行了文献检索，以确定评估阿司匹林预防该患者人群 VTE 的临床试验。检索词包括 MeSH 术语静脉血栓栓塞症；静脉血栓形成；肺栓塞；阿司匹林；膝关节置换术；髋关节置换术；和髋部骨折/手术。
任何评估阿司匹林的研究，甚至是与另一种预防方法（如气动压缩装置）联合使用的研究，只要在 1985 年或之后发表，均被纳入研究。
随机对照试验、荟萃分析和其他大型汇总和回顾性研究未能就阿司匹林作为全膝关节置换术（TKA）、全髋关节置换术（THA）或髋部骨折手术（HFS）患者 VTE 预防的一种选择的疗效和安全性得出一致结论。安全性和疗效替代标志物的适宜性存在分歧，导致 ACCP 和 AAOS 的建议也存在分歧。主要的争论在于深静脉血栓形成作为更严重结果（如肺栓塞）替代标志物的适宜性。
ACCP 和 AAOS 指南的最新变化对于选择阿司匹林进行 VTE 化学预防的人是一致的。目前的外科护理改进项目措施不包括阿司匹林作为预防 VTE 的合适单一选择，但对于接受选择性 TKA 或有药物预防禁忌并接受 THA 或 HFS 的患者，阿司匹林联合压迫装置作为多模式治疗的一部分将符合这些措施。数据不支持阿司匹林引起不良出血事件的可能性低于更有效的抗凝剂的假设。
